Treatments and drugs

Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you've made these important lifestyle changes and your cholesterol levels remains high, your doctor may recommend medication.

The specific choice of medication or combination of medications depends on various factors, including your individual risk factors, your age, your current health and possible side effects. Common choices include:

Bile-acid-binding resins. Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.

Cholesterol absorption inhibitors. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia can be used in combination with any of the statin drugs.

Combination cholesterol absorption inhibitor and statin. The combination drug ezetimibe-simvastatin (Vytorin) decreases both absorption of dietary cholesterol in your small intestine and production of cholesterol in your liver. It's unknown whether Vytorin is more effective in reducing heart disease risk than taking simvastatin by itself.

Medications for high triglycerides

If you also have high triglycerides, your doctor may prescribe:

Fibrates. The medications fenofibrate (TriCor) and gemfibrozil (Lopid) decrease triglycerides by reducing your liver's production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides.

Niacin. Niacin (Niaspan) decreases triglycerides by limiting your liver's ability to produce LDL and VLDL cholesterol. But niacin doesn't provide any additional benefit than using statins alone. Niacin has also been linked to liver damage and stroke, so most doctors now recommend it only for people who can't take statins.

Omega-3 fatty acid supplements. Omega-3 fatty acid supplements can help lower your cholesterol. You can take over-the-counter supplements, or your doctor may prescribe Lovaza, a prescription omega-3 fatty acid supplement, as a way to lower your triglycerides. These supplements may be taken with another cholesterol-lowering medication, such as a statin. If you choose to take over-the-counter supplements, get your doctor's OK first. Omega-3 fatty acid supplements could affect other medications you're taking.

Tolerance varies

Tolerance of medications varies from person to person. The common side effects are muscle pains, stomach pain, constipation, nausea and diarrhea. If you decide to take cholesterol medication, your doctor may recommend liver function tests to monitor the medication's effect on your liver.

Children and cholesterol treatment

Diet and exercise are the best initial treatment for children age 2 and older who have high cholesterol or who are obese. The American Academy of Pediatrics also recommends treatment with prescription drugs, such as statins, for children age 8 and older if a child has a high level of LDL cholesterol. However, this recommendation is controversial. The long-term effects of cholesterol-lowering drugs have not been extensively studied in children. In addition, certain cholesterol medications such as niacin are not recommended for children. Because of the disagreement in the medical community on this topic, talk to your child's doctor about the best way to lower your child's cholesterol.

Arsenault BJ, et al. Beyond low-density lipoprotein cholesterol: Respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women. Journal of the American College of Cardiology. 2009;55:35.

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary report. Pediatrics. 2011;128:S213.

AskMayoExpert. What are the newly released American College of Cardiology and American Heart Association guidelines for heart disease prevention (including new guidelines for treatment of cholesterol abnormalities) and what are Mayo's recommendations in response to these new guidelines? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.

Legal Conditions and Terms

Reprint Permissions

A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.